Diagnosis and treatment of spontaneous rupture of renal pelvis caused by pelviureteric junction obstruction in infants

Objective To analyze the clinical features of spontaneous rupture of the renal pelvis (SRRP) in infants caused by UPJO. Methods A retrospective analysis of 7 cases of SRRP in infants caused by UPJO in our hospital from October 2013 to October 2018 was performed. All the patients included 5 males and 2 females. The average age was(12.0±6.1) months(ranging 2 days-25 months). 3 cases suffered renal rupture in left side and 4 cases suffered renal rupture in right side. 2 cases had grade Ⅲ hydronephrosis and 5 cases had grade Ⅳ hydronephrosis. Other symptoms included fever in 4 cases, digestive symptoms in 3 cases, oliguria in 2. 7 cases were revealed RBC(+ + + )with urinary occult blood positive in urine test. 6 cases were found the white blood cells in urine was more than 8/μl. 3 cases had the elevated blood C-reactive protein.3 cases suffered with renal function insufficiency, which the creatinine was more than 110 μmol/L. The 2 cases of urinary extravasation was found in the posterior abdominal cavity and 2 in posterior abdominal cavity and abdominal cavity by CT enhanced scan. 4 cases performed open pyeloplasty, nephrostomy and perirenal drainage.2 cases performed pyeloplasty, nephrostomy, abdominal and perirenal drainage. 1 case performed perirenal drainage and retrograde indwelling Double-J stents. Results All operation performed successfully. The median operation time was 84 min (ranging 45-90 min). The estimate blood loss was 15 ml (ranging 10-35 ml)without any transfusion. The median time of postoperative perirenal drainage tube was 3 d (ranging 2-5 d), The median time of the abdominal drainage tube was 5 d (ranging 3-7 d), the median time of nephrostomy was 12 d (ranging 10-14 d). The median hospital stay was 14 d (ranging 10-21 d). The median follow-up was 18 months (ranging 3-36 months). One performed the second stage pyeloplasty after double-J stents removed, and the renal function gradually recovered. Conclusions The SRRP in infants caused by UPJO is rare and easily misdiagnosed. The degree of hydronephrosis and inflammation may be important factors affecting the spontaneous rupture of pediatric renal pelvis. When it occurs, it requires active intervention by the operation, while treating the stenosis of the UPJ and draining the extravasation of urine. Key words: Hydronephrosis; Spontaneous rupture of the renal pelvis; Ureteropelvic junction obstruction